February 06, 2010

The Checklist Manifesto

Issue No. 173 of Your Weekly Staff Meeting highlights a fascinating book on checklists—and how this “basic, basic, basic” tool can enhance teamwork and eliminate errors and disasters. Warning—the surgery stories are vivid! And this reminder, check out my Management Buckets website with dozens of resources and downloadable worksheets for your staff meetings.

Coming Events With John Pearson:

The Barnabas Group: Feb. 9-11. I’ll be speaking in San Diego, Orange County and Los Angeles on "The 3 Critical Questions You Must Ask—Before Saying 'Yes' to Serving on a Nonprofit Ministry Board of Directors." Visit the website.

2010 Workshops: Buckets, Boards and Strategic Planning. Check out the dates and locations for our 2010 workshops, including the next Nonprofit Board Governance workshop on March 11. Visit the website.

Fly the Airplane!

I’ve mentioned before that I measure a great book by how often I’m reading sections to my long-suffering wife/listener, Joanne. Another indicator: I read the book slowly, tasty morsel by tasty morsel. Lastly, there’s serious emotion when I turn the last page—somehow hoping it could go on and on. This book scores 10s on all counts.

Really? A book about checklists is that good? Yes. If you enjoyed Malcolm Gladwell’s Outliers, you’ll love this one.

[x] 1. Atul Gawande, a surgeon and staff writer for The New Yorker, leads the World Health Organization’s Safe Surgery Saves Lives program. If you didn’t believe in checklists before, you’ll be a born-again checklist-maker after Chapter 1.

[x] 2. He quotes a 1970s study on “necessary fallibility.” It cites two reasons we fail at stuff: a) ignorance and b) ineptitude. In the latter, “…the knowledge exists, yet we fail to apply it correctly.”

[x] 3. Caution! If you’re having surgery soon, or have friends or family facing the knife, you may want to skip this book—or ask your surgeon’s views on operating room checklists. (In a recent global experiment, a two-minute pre-surgery team review of a standard checklist has dropped infection rates, death rates and complication rates by a staggering amount.)

[x] 4. Pilots have long been the checklist gurus—but the art and science of well-crafted checklists have not found favor in other professions or industries…yet. The Captain Sully story, though expected, still caused my heart to beat fast. You’ll appreciate how checklists saved the day for the “Miracle on the Hudson.”

[x] 5. The chapter, “The End of the Master Builder,” takes you into the elite world of checklists created under the hardhats of McNamara/Salvia, a Boston high rise construction firm. The dingy construction trailer is long gone. In its place, “…on the walls around a big white oval table, hung sheets of butcher-block-size printouts of what were, to my surprise, checklists.”

[x] 6. Checklists are “ridiculously simple.” What seems obvious, isn’t. Checklists enhance teamwork—even among virtuoso surgeons. “There’s a reason much of the world uses the phrase, operating theater.”

[x] 7. Boeing’s checklist expert uses “pause points” when building checklists for pilots in crisis. Within each pause point, he limits the checklist to between five and nine items. I had no idea that there were checklist connoisseurs.

[x] 8. For crisis lists, decide whether you want a DO-CONFIRM checklist (do what your gut tells you, then go back and confirm you did it) or a READ-DO checklist (more like a recipe).

[x] 9. Gawande interviewed the managing partner of a California investment firm who is a checklist zealot. He cited the “cocaine brain” that researchers often experience when investigating company financial reports. Without a thorough checklist (honed over years of experience), a greed mode kicks in and wipes out thoughtful discernment. They use a “Day Three Checklist” to avoid disasters. “Forty-nine times out of fifty, he said, there’s nothing to be found. ‘But then there is.’”

[x] 10. “Fly the airplane,” amazingly, is the first item on a checklist for engine failure on a single-engine Cessna airplane. “Because pilots sometimes become so desperate trying to restart their engine, so crushed by the cognitive overload of thinking through what could have gone wrong, they forget this most basic task. FLY THE AIRPLANE.”

In one study of 250 staff members (surgeons, anesthesiologists, nurses and others), 80 percent reported that the new checklist had improved the safety of care and 78 percent “actually observed the checklist to have prevented an error in the operating room.” Yet, 20 percent gave it a thumbs down.

Then Gawande asked one more question, “If you were having an operation, would you want the checklist to be used?” A full 93 percent said yes!

Your Weekly Staff Meeting Questions:1) The author notes a study on the “science of complexity.” The researcher defined three levels: simple (use a recipe to bake a cake), complicated (sending a rocket to the moon), and complex (raising a child). How much of your work time do you devote to these three levels?2) Does this “manifesto on checklists” intrigue us enough so that someone here should read the book and report on it in a month?

5-Step Crisis Card - Insights from Mastering the Management Buckets: 20 Critical Competencies for Leading Your Business or Nonprofit

One of the big ideas in the Crisis Bucket, Chapter 13, in Mastering the Management Buckets, is to create simple, step-by-step instructions and plans BEFORE a crisis hits. For example, World Vision has an Emergency Response and Disaster Mitigation (ERDM) team. Team members carry a wallet-size, laminated card with instructions on what to do when disaster strikes.

To review World Vision’s five-step card, download and read the article, "We've Got an Emergency: Essential Lessons Every Manager Needs to Learn Before a Crisis Hits" (The Inside Story of How World Vision Responded to the Tsunami Disaster). Visit the Crisis Bucket webpage.